|Volume 21, Number 2||Fall, 1994|
A competent, very well-trained clinical investigator and teacher at our institution recently said to me, "I'd like to do sophisticated clinical research on spontaneously occurring diseases of animals but I don't have the time, the training, the support, or the cases."
A veterinarian who recently completed a PhD degree in molecular genetics in an absolutely outstanding basic science program in medical school said, "I went to veterinary school specifically to prepare for a career in research in molecular genetics. I'm glad I did, but I hated veterinary school."
A respected senior faculty member of a well-established college of veterinary medicine commented, "It used to be much easier to teach because students and faculty were all alike and most students did similar things after graduation."
The Diversity Challenge
These quotes are illustrative of a major challenge facing veterinary medical education, which perhaps, can best be captured by the term "diversity." Common usage often links this word with ethnic diversity and, certainly, there's nothing wrong with that application. The term is used here to refer to diversity in the broadest perspective. Our applicants are diverse, not only because of their gender and ethnic differences, but also because of their upbringing (rural vs. urban), career interests and aspirations (small animal practice, research, academic veterinary medicine, government service, industry), age (the age range in a recent graduating class was 25-48 years), perspectives towards teaching, family considerations and life experiences (animal trainers, lawyers, CPAs, PhDs, etc.). Thus, the faculty not only confronts an increasingly diverse student population, but, in addition, is increasingly diverse itself with a broad range of interests, opportunities and challenges. These differences clearly influence institutional loyalty and behaviors. Faculty members may feel a stronger loyalty to their specialty board organization or other professional peer group than they do their college or university.
We are being encouraged to develop diversity in our curricula. Programs such as the Pew National Veterinary Education Program (PNVEP) have encouraged us to recognize that colleges cannot be all things to all people and that some differences among us would, indeed, be productive and healthy. Thus, in addition to the usual geographic, financial and university pressures to be "different", we are now strongly encouraging ourselves and each other to nurture and enhance diversity within and between colleges of veterinary medicine.
Veterinarians are pursuing diverse careers, indeed, with our encouragement and support. aquaculture, ranched wildlife, food safety, industrial research, biotechnology and a plethora of clinical specialties are all career opportunities that are available for veterinarians. We are advocating these choices actively within our student body and extending this encouragement to our graduates who may be considering career changes.
One of the major challenges facing veterinary medical education, then, is the demand that we enhance and reward diversity at all levels while at the same time facing static or declining financial resources, which decrease our flexibility and preclude any possibility of "having our cake and eating it too." What strategy might we then use to approach the problem? We must begin by encouraging a broad, balanced view of veterinary medical education. It is no longer realistic or possible to expect any single participant in the broad fabric of veterinary medical education to have the same degree of all-inclusiveness that has driven so much of our decision making in past decades. The "cookie-cutter" approach has been used to describe traditional veterinary medical education. Obviously making a single kind of "cookie" with a single "cookie cutter" requires a relatively simple machine. This fairly simple machine can do all of the necessary steps to produce the cookie. When, however, one wants to make not only different shapes of cookies but different kinds and would like to include some cupcakes and pies, no single machine can take all the necessary steps. This analogy can be applied to individual faculty members or entire colleges of veterinary medicine.
Schools and colleges can afford to be different. It is neither necessary nor appropriate that we all attempt to carry out the incredible breadth of academic mission that is appropriate for veterinary medicine in North America. Already, in fact, we are seeing evidence of effective "college specialization" and sharing of resources among colleagues to achieve a whole that is greater than the sum of its parts. Examples that are now frequently cited include the Food Animal and Aquatic Pathobiology Consortia, both of which were the result of PNVEP. Many other changes are taking place as well. In our own College, for example, we have chosen to establish a section on wild and exotic animal medicine because of the rapidly increasingly importance of this industry in Texas. To establish this section, different departments within the College of Veterinary Medicine are collaborating with each other as well as with the Department of Wildlife and Fisheries Sciences in the College of Agriculture and Life Sciences. In addition, we are hoping to develop a program with another university within the Texas A&M University System.
Another strategy which should be considered is to eliminate tenure and adopt rolling contracts for faculty members. We are placing nearly impossible demands on our faculty when we expect them to be highly competent teachers and NIH-funded researchers as well as practice the most advanced forms of veterinary medicine and surgery simultaneously. In fact, we all know this expectation is unrealistic or impossible (with the exception of a few extraordinary people). Statements in guidelines on promotion and tenure are indicating more frequently that exceptional performance in two of the three areas is acceptable. Indeed, some indicate that exceptional performance in only one, with strong performance in the second and minimal competency in a third area is appropriate. At the same time, we are finding that it is more and more difficult to reward people who do an excellent job in teaching, delivering primary veterinary care, providing high quality continuing education or performing the incredible array of tasks necessary to keep a modern college functioning. Consider the amount of time a faculty spends in important college committees such as admissions, curriculum, or promotion and tenure, let alone the amount of time they spend on departmental committees, university search committees, etc. Is it reasonable anymore to maintain the present program of permanent academic positions and the up-or-out rule of tenure? We need to adopt strategies already in use by some medical schools and at least the clinical component of one veterinary school, namely rolling, multi-year contracts instead of tenure. The advantages are obvious. Colleges can have increased flexibility and faculty members can be offered time to retool under circumstances in which the administration has both a stick and a carrot. We are placing ourselves in an untenable position if we believe that we can anticipate our curricular, research and patient care needs so accurately that we can afford to give faculty members lifetime contracts based on how well they perform in a five- to six-year probationary period. Further, I believe the taxpayers will soon revolt against a system that has become archaic in a country with a plethora of laws prohibiting discrimination based on age, gender, ethnicity, disability, religion, etc.
Other strategies for coping with diversity include offering opportunities for students to have a focus within the broad subject of veterinary medicine. Many schools are developing variations on this particular theme. The idea of students "tracking" or concentrating in a particular species or area of expertise seems to be highly controversial to veterinarians in the field, and yet their behaviors belie their statements. Some schools are moving more aggressively than others in this direction, but this seems to be a strategy whose time has come. Accompanying this, however, must be multiple opportunities for post-DVM retraining. Not only those students who focused intensively during their formal DVM training need to have opportunities to redirect their careers, but also, practicing veterinarians (in the broadest sense) need the chance to redirect their careers. This is a major challenge for continuing education. One of the big challenges in veterinary medical education today lies at the level of post-DVM learning.
There are many strategies that can be used to cope with the need for diversity including collaborating with departments in the College of Veterinary Medicine to share faculty. This is done frequently in research but should be much more widely applied to the classroom and in the clinics.
The college of veterinary medicine of the future that is judged highly successful will be one that has determined how to enrich itself through diversity. Diverse people, life experiences, career aspirations and intellectual perspectives will characterize the faculties and students of the future. The colleges and departments that are successful in not only accommodating diversity but strengthening themselves in the process will be successful programs of the next two decades.
The Curricular Challenge
A dedicated young clinical faculty member recently noted, "We really don't aim our clinical teaching toward the fourth-year student. Many hospital patients have conditions that are too complex and atypical for senior students." At the same time a practitioner commented, "New graduates are well trained -- full of knowledge and excitement -- but totally impractical. They have no working knowledge of finances, too few people skills, and too little experience with everyday problems."
Biomedical sciences will continue to be supplied with more and better "tools" that give us increasingly detailed "views" of structure and function. Whether it is the color-Doppler ultrasound unit extending the "view" offered by the stethoscope or the analysis of gene sequences instead of hemograms, we have more and more information, coming at an increasing rate. Thus, the challenges of making education relevant and practical yet solidly based in modern, basic and clinical sciences is a major one. As already observed, veterinary medical education contains too much information and too little thinking and analysis, too much memorization and too little understanding, too much listening and too little involvement or criticism and too much sitting with too little acting. Multiple challenges are embedded in this issue. They include not only deciding the specifics of course content (i.e., "what's in and what's not") but also teaching and learning skills in information management. There is a nearly universal agreement that there is too much information and it is accumulating too quickly to be taught and mastered in the "traditional" curriculum. On the other hand, changes in attitudes come slowly and, to date, we have not successfully resolved this dilemma. Continuing efforts are essential, however, and new approaches will be developed, tried and either adopted, modified or discarded according to the success with which they address this fundamental problem. In addition, we have often been accused of forgetting the human element in teaching and learning. Thus, we must look for ways in which we can not only manage increasing amounts of information, but we must also increase opportunities for students to acquire skills in communication. Students must learn in environments in which they can enhance their abilities to respond with concern and sensitivity to the real problems of the people they serve and to develop trust and confidence in their peers, co-workers and clients. Further, veterinary medicine remains an art as well as a science. Despite the increasingly sophisticated "views" of biological systems afforded us by the tools of modern science, clinical judgment and rational decision making in the face of ambiguity and incomplete information lie at the heart of the successful practice of veterinary medicine.
A variety of approaches has been used in an attempt to keep education in pace with the exploding body of scientific information. Strategies have included fewer lectures with more group study and more library time; integrated teaching involving basic and clinical scientists; limiting course contents to "medically relevant" information; teaching from clinical problems; and even re-organizing schools to integrate basic and clinical science departments. Recognizing the difficulties of changing faculty attitude and persuading them to adopt these approaches, some schools have even gone so far as to assign a "curriculum czar." Although each of the strategies listed above (and many others) has been tried and some have been found to be somewhat helpful, no solution has yet emerged that is so successful that it is adopted universally. Nevertheless, we must continue to struggle to change the student's approach from passive to active, including such strategies as problem-based curricula, interactive learning resources and increased student choices.
Collaborative learning has been offered as one strategy and has been tried with substantial success in several schools. Collaborative learning should not be mistaken as clinical problem-based learning since the latter focuses primarily on the use of clinical cases as illustrative examples, whereas collaborative learning concentrates in creating environments in which all participants collaborate and become mutually supportive to enhance each individual's information and skill acquisition. Collaborative learning is effective, builds teams, and stimulates student involvement. Collaborative learning is enriched by diversity, results in eager students and demonstrably enhances intellectual achievement and practical accomplishments. It is a strategy that should receive wide attention and implementation in veterinary medical education. "Collaborative learning" can also be very frustrating to students if they do not have enough time to work as a group or, if they have minimal skills in team learning (and are not provided those skills).
Unified basic science/clinical science examination would greatly assist in concretely defining how much students need to know and would assist both faculty and students in understanding how basic information applies to clinical problems and, conversely, how dependent advances in clinical medicine are on basic science information. This strategy may be simpler, much less expensive and more easily implemented than collaborative learning. It offers some opportunities for change although probably not of the same order of magnitude as collaborative learning. Examinations are the major pressure points for students, and for most students, examinations define the curriculum. Unified exams can be cost- and time-effective and can provide immediate feedback to students and faculty in an environment which both educated and re-educates students and faculty. This a strategy worth exploring!
Increasingly rapid change and extensive diversity will characterize veterinary medical education for at least the next one to two decades. This prediction argues that flexibility and choice for both students and faculty will characterize the successful curricula of the future. Addressing people skills and the issues of professionalism as well as the management of the increasingly large and sophisticated body of biomedical information will be required. Those schools that do it well will succeed in convincing their faculty, students, universities and state citizens that the precious resources of time and money are being applied well and that veterinarians are emerging who can, and will, address the real needs of society and will provide leadership to resolve the problems and meet the challenges of the future. Strategies such as collaborative learning, the better utilization of mentors as role models, and increasing skills in information management will be among the tools employed by faculty and students to rise to the challenges of the future.
References and Endnotes
1. Bromley DA: Life sciences and biotechnology in the coming decades FASEB Newsletter. pp.2-3, Jan/Feb, 93.
2. Edwards G and Snyder DP: It's Time to Re-invent Higher Education: A Strategic Assessment. Copyright Gregg Edwards and David Pearce Snyder. E.S. Press,1993.
3. Marston RD and Jones RM (Eds): Medical Education in Transition. Commission on Medical Education; The Science of Medical Practice. Princeton, NJ: The Robert Woods Johnson Foundation. 1992
4. Pritchard W: Future Directions for Veterinary Medicine. Durham, NC: Pew National Veterinary Education Program, Duke University. 1989.
5. Schilling KM and Schilling KL: Point of view: professors must respond to calls for accountability. Chronicle of Higher Education 39 #29, pA40 (24 Mar) 1993.
6. Smith KA: Cooperative learning and problem solving. Cooperative Learning and College Teaching. Vol. 3 No. 2, Winter 1993.
7. Womack JE: Molecular genetics arrives on the farm. Nature 360:108-109, 1992.
8. This presentation benefitted by discussions with many colleagues and especially Texas A&M College of Veterinary Medicine colleagues, Drs. William J. Banks, Teresa W. Fossum, W. R. Klemm and Alice M. Wolf.